Cushing syndrome with secondary adrenal insufficiency from concomitant therapy with ritonavir and fluticasone

We present 2 cases of Cushing syndrome with secondary adrenal insufficiency from concomitant use of ritonavir and inhaled corticosteroids in children with human immunodeficiency virus infection. These cases highlight the need for special consideration when treatment with an inhaled/intranasal corticosteroid is indicated in children receiving antiretroviral therapy.

Abbreviations:  ACTH, Adrenocorticotropic hormone , ART, Antiretroviral therapy , BID, Twice a day , CYP 3A4, Cytochrome P450 3A4 enzyme system , EFV, Efavirenz , HCRT, Hydrocortisone replacement therapy , HIV, Human immunodeficiency virus , ICS, Inhaled corticosteroids , LPV, Lopinavir , PCP, Pneumocystis jiroveci pneumonia , PI, Protease inhibitor , RTV, Ritonavir